The Artvoice reported today that Blue Shield California twice refused to pay $2,700 emergency room claims by Rosalinda Miran-Ramirez, concluding that it was not a “reasonable” decision for her to go to the emergency room that morning when she awoke to a shirt saturated from blood with what turned out to be a breast tumor. Only after KPIX-TV reported the story did the insurance company pay the claim. Further, it reported that the National Women’s Law Center found that the laws of eight states permit insurance companies to deny health coverage to a battered spouse (as a “pre-existing condition”) since batterers tend to be recidivists.
Law Regarding Proper No-Fault Submissions And Denials For Peer Reviews
March 7, 2013
An applicant establishes a prima facie showing of its entitlement to No-Fault benefits as a matter of law by submitting evidentiary proof that the prescribed statutory billing forms had been mailed and received and that payment of No-Fault benefits were overdue. Sunshine Imaging Association/WNY MRI v. Government Employees